RESUMEN
PURPOSE: To investigate surgical outcome, long-term stability, the time course of relapse, neurosensory disturbances, and patient satisfaction after BSSO for correction of mandibular asymmetry. Another objective was to examine whether osteotomies for transverse rotation of the distal segment represent an increased risk for nerve injury. SUBJECTS AND METHODS: In a retrospective study lateral and postero-anterior cephalograms, information from patient files and questionnaires were analysed for 38 patients having more than 4 mm asymmetry at the chin pre-treatment (mean 8.4 mm). The radiographs were analysed preoperatively, postoperatively, after 6 months and 3 years. RESULTS: Asymmetry of the chin to the facial midline improved on average by 56%. Skeletal relapse was about the same for transverse and antero-posterior surgical changes (10-15%). 58% of the patients had asymmetry of more than 3 mm at menton 3 years post-surgery. Discrepancy between upper and lower dental midlines improved on average 80%. Normal or near normal sensation to the lower lip/chin was reported by 44% of the patients which is similar to sensory disturbances after BSSO straight set-back performed by the same surgical team. A difference in the incidence of neurosensory disturbance between the two osteotomy sides was observed. Satisfaction with the treatment result was reported by all patients except for two. CONCLUSION: Correction of mandibular asymmetry by BSSO is fairly stable. Although the risk for sensory impairment for the individual patient was similar to impairment in a sample having straight setback, rotation of the distal segment during surgery may represent an increased risk for sensory impairment on the deviating side (P = 0.06). Three years after surgery patients were generally satisfied with the result even if more than 3 mm of asymmetry at the chin remained for 58%. The findings have implications for treatment planning and the decision to elect one-jaw, bimaxillary surgery and/or additional genioplasty.
Asunto(s)
Asimetría Facial/cirugía , Mandíbula/cirugía , Osteotomía Sagital de Rama Mandibular/métodos , Satisfacción del Paciente , Prognatismo/cirugía , Actitud Frente a la Salud , Cefalometría/métodos , Mentón/inervación , Mentón/cirugía , Estudios de Seguimiento , Humanos , Labio/inervación , Maloclusión de Angle Clase III/cirugía , Mandíbula/patología , Nervio Mandibular/fisiopatología , Osteotomía Sagital de Rama Mandibular/psicología , Planificación de Atención al Paciente , Complicaciones Posoperatorias , Recurrencia , Reoperación , Estudios Retrospectivos , Rotación , Trastornos Somatosensoriales/etiología , Resultado del Tratamiento , Traumatismos del Nervio Trigémino/etiologíaRESUMEN
AIM: To examine factors associated with patients' decision to decline surgery. MATERIAL/METHODS: Of 470 consecutive patients referred to the University of Oslo from 2007 to 2009, a sample of 160 subjects who had not undergone surgery was identified and contacted. 236 operated patients from the same period served as a comparison group. Morphology was assessed from cephalograms and photographs, and the individuals' opinions were recorded using questionnaires. RESULTS: Dentofacial morphology represented normative treatment need and was generally similar except for a higher rate of severe negative overjet in the operated group (p < 0.001). The most prevalent reasons for declining surgery were risks of side effects, the burden of care, and a general reluctance to undergo surgery. Many un-operated subjects were dissatisfied with their masticatory function and dentofacial appearance. CONCLUSION: Informed consent to orthognathic surgery represents a challenge both to the patient and the professional. The findings imply that patients' motives and fears should be explored during consultation and that the information provided should be adapted to the potential risks and benefits related to the actual treatment.
Asunto(s)
Maloclusión/cirugía , Procedimientos Quirúrgicos Ortognáticos/psicología , Negativa del Paciente al Tratamiento , Adolescente , Adulto , Actitud Frente a la Salud , Cefalometría/métodos , Toma de Decisiones , Estética , Asimetría Facial/psicología , Asimetría Facial/cirugía , Miedo/psicología , Femenino , Mentoplastia/psicología , Humanos , Consentimiento Informado , Masculino , Maloclusión/psicología , Osteotomía Mandibular/psicología , Masticación/fisiología , Motivación , Osteotomía Le Fort/psicología , Osteotomía Sagital de Rama Mandibular/psicología , Satisfacción del Paciente , Fotograbar/métodos , Adulto JovenRESUMEN
PURPOSE: The aim was to compare outcome after extraoral vertical subcondylar osteotomy (EVSO) with rigid fixation and bilateral sagittal split osteotomy (BSSO) for correction of mandibular prognathism. The objectives were to examine treatment factors, postoperative results, and long-term stability. The surgical technique for EVSO is presented in detail. SUBJECTS AND METHODS: Lateral cephalograms and information from patient files of 65 consecutively operated patients with EVSO and 65 matching patients operated with BSSO were analyzed preoperatively, postoperatively, after 6 months and 3 years. RESULTS: No clinically significant differences were observed in long-term stability. The retromandibular scar inferior to the earlobe after EVSO was on average 25 mm long and 1 mm wide, and was of no concern for most of the patients. Normal or near normal sensation to the lower lip/chin was reported by half of the BSSO patients at the 3-year follow-up. CONCLUSION: Because no major differences in outcome were observed, EVSO with rigid fixation may be considered as a viable alternative if it is important to avoid alterations in sensation, whereas BSSO may be preferred if retromandibular scar is of concern.